Pustulosis palmaris et plantaris. With reference to the cross-reactivity between tonsillar epithelium antigen and skin antigen.

Though it is well known that pustulosis palmaris et plantaris (PPP) is one of skin diseases caused by focal infection of the tonsils, its etiology remains unknown. The purpose of this study was to elucidate the role of the tonsils in the pathogenesis of PPP, by using histological and immunological techniques. Our findings were as follows: The common histological findings in tonsillar lacunae of patients with PPP were pus plugs, pronounced infiltration of polymorphonuclear cells and mononuclear cells, desquamation of keratinized squamous cells, uneven thickness of the epithelium, and inflammation of the subepithelial area. By applying Arthur's method, skin extracts of sole (S) and epithelial extracts of tonsillar lacunae (T) were prepared as antigens for rabbit immunization. Cross-reactivity between skin extract of sole and epithelial extract of tonsils was tested using the Ouchterlony technique. Anti-T antisera reacted to both T and S. Anti-S antisera reacted similarly to T and S. Direct and indirect immunofluorescence studies using anti-T and anti-S antisera revealed positive staining either in the lacunal epithelium of tonsil or in the corneous, granular and papillary layers of sole. As regards the pathogenesis, it is suggested that the antigenic modification of tonsillar epithelium caused by various stimuli produces cells and/or antibodies so as to challenge against skins.